Key points

Particular care should be taken when prescribing testosterone to patients with late-onset hypogonadism

Further longer-term clinical trials are needed to assess the impact of testosterone treatment on patients with late-onset hypogonadism

What information does this statement cover?

The Society for Endocrinology has produced a position statement to put forward our view on the diagnosis and treatment of male hypogonadism (low levels of the sex hormone testosterone) and the relation of this to the ageing process. The position statement is aimed at medical professionals who may encounter male patients with hypogonadism. The purpose of the position statement is to harmonise good clinical practice and standardise the UK approach in this field.

What is hypogonadism?

Hypogonadism is a medical term that describes the condition where the sex glands do not produce enough hormones. For men, this is when the testes produce too little of the hormone testosterone. In men, testosterone is important for general health, as well as sexual health.

In adult men, symptoms of hypogonadism may include decreased sex drive, loss of morning erections and erectile dysfunction, but may also involve tiredness, reduced physical strength and endurance, loss of motivation and concentration, irritability and low moods.

Male hypogonadism can be divided into two groups. Classical hypogonadism is where the low levels of testosterone are caused by an underlying specific medical condition, for example Klinefelter's syndrome, Kallman's syndrome or a pituitary tumour. Late-onset hypogonadism is where the decline in testosterone levels is linked to general ageing and/or age-related diseases, particularly obesity. It is estimated that late-onset hypogonadism only affects a small number of men over the age of 40.

How should male hypogonadism be diagnosed?

Many of the symptoms of male hypogonadism are non-specific and can be caused by a range of conditions. Therefore, when diagnosing hypogonadism, it is important that biochemical tests are performed to assess the levels of testosterone in the blood to confirm diagnosis. Several blood tests must be taken on different days to measure the total levels of testosterone. In all cases, the blood test should be taken before 11am. This is because the amount of testosterone that the body produces varies according to the time of day; therefore it is important to standardise the time at which a sample is taken to ensure that the results are interpreted correctly.

If the total amount of testosterone in the blood is lower than the reference range on at least two occasions, this supports the diagnosis of male hypogonadism. If the results are borderline, further diagnostic tests may be carried out to confirm the diagnosis. These could include measuring levels of other related hormones in the blood or the calculation of free (or unbound) testosterone levels (most testosterone travels in the bloodstream bound to another protein).

How should hypogonadism be treated?

For patients who have been diagnosed with classical male hypogonadism, the use of testosterone treatment is safe and effective.

For patients who have been diagnosed with late-onset hypogonadism, there is currently not enough evidence for us to know whether treatment with testosterone is safe and effective over the long-term. While there are some short-term studies that indicate it may benefit these patients over a short period of time, there is a need for longer-term clinical trials in this area, following a large number of patients, to assess the long-term impact of testosterone treatment on patients with late-onset hypogonadism. Areas that particularly require focus are assessing the effects of treatment on the likelihood of developing cardiovascular disease, prostate cancer and secondary polycythaemia (a condition where too many red blood cells are present in the blood).

Consensus statement from the International Society of Andrology, International Society for the Study of the Ageing Male, European Association of Urology, European Academy of Andrology and American Society of Andrology: Wang et al. (2008). Eur J Endocrinol,159:507-514.

In addition, there are a number of patient groups who can provide advice and support to patients and their families with certain causes of classical hypogonadism. The websites of some of these groups are listed below.

If you have any concerns regarding your own health, you should consult with your GP in the first instance.

How was the position statement produced?

The position statement was produced by members of the Society for Endocrinology’s Clinical Committee. The Society for Endocrinology is the UK learned society that represents doctors, scientists and nurses who work on hormones and hormone-related conditions.